Posterior chamber iris‐claw lens combined with vitrectomy: surgical technique and refractive analysis

Abstract

Abstract Purpose To present a new surgical technique of vitrectomy and implantation of posterior chamber iris‐supported IOL and to evaluate the safety in eyes with inadequate zonular support and lens dislocation. Also, to study the refractive result and select the proper A constant ‐ formula for IOL power calculation. Methods 27 eyes (23 patients) having IOL‐capsule vitreous dislocation were included. Pseudoexfoliative glaucoma was present in 11 cases. The procedure involved pars plana vitrectomy, extraction of the dislocated IOL‐capsule, Artisan–Verysise IOL insertion in the posterior chamber and iris enclavation without peripheral iridectomy. Measurements were performed by IOL Master and scanning endothelial microscope. The refractive outcome and any complications were evaluated. Results The follow‐up period was 8‐24 months. Improvement in visual acuity was found in all 27 eyes. Postoperative refractive errors were within 1,5 D and the induced astigmatism was within 2 D. Complications such as retinal detachment,keratopathy, visual instabilities, or glaucoma progression were not found. The IOL was slightly eccentric in 4 cases. In 2 eyes single haptic subluxation was noticed and was relocated with second procedure. Temporary cystoid macular edema was observed in 4 eyes. Conclusion The management of cases having serious pseudoexfoliation and IOL dislocation with vitrectomy and posterior chamber iris‐claw IOL implantation seems to provide a safe alternative method with favorable outcome and satisfactory anatomic restoration combined with anterior segment protection. The power of Artisan–Verysise should be calculated with a new A constant (116,7–116,8), depending on the applied formula.